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RAND Review News for Summer 2003

Crises Seen as Catalysts for NATO and EU

NATO and the European Union (EU) have certainly endured crises in the last
year, but such conflicts will ultimately lead to stronger, more unified organizations,
according to France's Ambassador to the United States Jean-David Levitte, who
spoke recently at RAND.

The ambassador acknowledged that the U.S.-led war on Iraq had shaken NATO but
said that the organization has since recovered. NATO enlargement also signals
the beginning of a new era, he said.

"We are transforming NATO into a completely different organization,"
said Levitte. "The Soviet Union has disappeared, and the threat now is
terrorism."

Similarly, Levitte noted that although the EU has suffered from dissension,
it is also on the road to reform. In fact, past experience has demonstrated
that a European crisis is sometimes the catalyst for progress. "It's when
we have a challenge, when something goes wrong, that we say 'let's do it better
next time.'"

Levitte reminded the audience that the European Constitution is now being prepared.
"If all goes well, in a few months, Europeans will have a president—a
man, a voice, a face for the European Union."

However, Levitte emphasized that the goal of creating a constitutionally unified
Europe is not to build a counterweight to U.S. power. Developing a common defense
and foreign policy will help create "a common force strong enough to take
care of crises at our own doors," he said, referring to the past Balkan
crises.

Hispanic Immigrants Show Familiar Progress

Hispanic immigrants to the United States advance socially and economically
from generation to generation as quickly as European immigrants did decades
earlier, according to a RAND study published in the American Economic Review.

"Based upon our experience with history, the children and grandchildren
of Hispanic immigrants progress up the educational and income ladder in the
same way as immigrants who came here from European countries," said James
Smith, RAND economist.

The advancement leaves thirdgeneration Hispanic descendants only about 10 percent
behind their white counterparts in relative incomes. The generation-to-generation
educational gains made by Hispanic men are greater than those seen among native-born
white and African-American men. However, by the third generation, the educational
gains appear to drop off as the statistics for Hispanics begin to resemble those
of the remaining U.S. population.

"A lot of the success we have seen from immigrant groups is because of
the strong American school system," said Smith. "If the schools fail
to deliver, then we have a problem. While history provides an optimistic lesson,
there is no guarantee that new immigrants will keep moving upward unless we
continue to have a sound educational system.

Disparity Found Among California Charter Schools

California's charter schools produce substantial dissimilarity in student performance
at different types of charter schools, according to a new RAND study.

Charter schools are designed, in part, to compete with conventional schools.
At least 38 states allow charter schools, with nearly 2,700 of them enrolling
more than 600,000 students. California has more than 400 publicly funded charter
schools enrolling about 150,000 children.

"Charter schools differ markedly from each other, and consequently there
is no single charter school effect on student achievement," said Ron Zimmer,
lead author. "From campus to campus, charter schools are so diverse it
is impossible to paint a single picture of them. To precisely evaluate performance,
you need to consider the type of charter school and the characteristics of the
specific charter."

The report recommends that the state create a system of tracking student academic
advancement over time and also require that fiscal information from charter
schools be monitored by state departments of education, county offices of education,
and local school districts. The report further calls for additional research
on charter schools that provide a significant amount of instruction outside
the classroom.

For more information: Charter School Operations and Performance: Evidence from
California (RAND/MR-1700-EDU). Full Document

America Scores Low on Quality of Health Care

Adults in the United States receive, on average, just over half of the health
care recommended for a variety of common ailments, according to a study published
in the New England Journal of Medicine.

The national study, the largest and most comprehensive ever conducted on health
care quality, found that such deficiencies of care pose "serious threats
to the health of the American public" and may contribute to thousands of
preventable deaths every year.

"Most of us take health care quality for granted. This study shows that
we can't," said RAND's Elizabeth McGlynn, who led the study. "There
is a tremendous gap between what we know works and what patients are actually
getting."

Among the findings, based on interviews and on reviews of medical records:

Pneumonia patients receive just 39 percent of recommended care. Nearly 10,000
deaths from pneumonia could be prevented annually through vaccinations.

Diabetics receive only 45 percent of the care they need overall. Even worse,
less than 25 percent of diabetics have their blood sugar levels measured regularly.
Poor control of blood sugar can lead to kidney failure, blindness, and amputation
of limbs.

High blood pressure patients receive less than 65 percent of recommended
care. Poor blood pressure control increases the risks of heart disease and
stroke and contributes to more than 68,000 preventable deaths annually.

Heart disease patients receive 68 percent of recommended care.

Overall, patients failed to gain access to proper medical care about 46
percent of the time.

"What's needed are information systems that can measure care routinely
and be linked to systematic efforts to improve quality," said co-author
Steven Asch.

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